Epidemiology of Clostridium difficile infection in hospitalized oncology patients

Chang, Gina Y.; Dembry, Louise‐Marie; Banach, David

doi:10.1016/j.ajic.2016.04.210

Cited by 13 publications

(9 citation statements)

References 9 publications

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“…95 Patients with cancer are at a high risk for developing resistant organisms and complications, such as C difficile infection. 96,97 Thus, efforts to evaluate reported penicillin allergy in patients with cancer may improve treatment decisions and potentially affect outcomes, such as hospital length of stay. 94 Interventions for clinical evaluation implemented in either outpatient or patient settings, ideally before the initiation of chemotherapy or bone marrow transplant, may improve outcomes.…”

Section: Oncologymentioning

confidence: 99%

Evaluation and Management of Penicillin Allergy

Shenoy

Macy²,

Rowe

et al. 2019

JAMA

593

531

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IMPORTANCE β-Lactam antibiotics are among the safest and most effective antibiotics. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events.OBSERVATIONS Approximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. Although many patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte-mediated penicillin hypersensitivity is uncommon (<5%). Currently, the rate of IgE-mediated penicillin allergies is decreasing, potentially due to a decreased use of parenteral penicillins, and because severe anaphylactic reactions to oral amoxicillin are rare. IgE-mediated penicillin allergy wanes over time, with 80% of patients becoming tolerant after a decade. Cross-reactivity between penicillin and cephalosporin drugs occurs in about 2% of cases, less than the 8% reported previously. Some patients have a medical history that suggests they are at a low risk for developing an allergic reaction to penicillin. Low-risk histories include patients having isolated nonallergic symptoms, such as gastrointestinal symptoms, or patients solely with a family history of a penicillin allergy, symptoms of pruritus without rash, or remote (>10 years) unknown reactions without features suggestive of an IgE-mediated reaction. A moderate-risk history includes urticaria or other pruritic rashes and reactions with features of IgE-mediated reactions. A high-risk history includes patients who have had anaphylaxis, positive penicillin skin testing, recurrent penicillin reactions, or hypersensitivities to multiple β-lactam antibiotics. The goals of antimicrobial stewardship are undermined when reported allergy to penicillin leads to the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance, including increased risk of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. Broad-spectrum antimicrobial agents also increase the risk of developing Clostridium difficile (also known as Clostridioides difficile) infection. Direct amoxicillin challenge is appropriate for patients with low-risk allergy histories. Moderate-risk patients can be evaluated with penicillin skin testing, which carries a negative predictive value that exceeds 95% and approaches 100% when combined with amoxicillin challenge. Clinicians performing penicillin allergy evaluation need to identify what methods are supported by their available resources.CONCLUSIONS AND RELEVANCE Many patients report they are allergic to penicillin but few have clinically significant reactions. Evaluation of penicillin allergy before deciding not to use penicillin or other β-lactam antibiotics is an important tool for antimicrobial stewardship.

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Section: Oncologymentioning

confidence: 99%

Evaluation and Management of Penicillin Allergy

Shenoy

Macy²,

Rowe

et al. 2019

JAMA

593

531

View full text Add to dashboard Cite

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“…Metronidazole has intrinsic activity against C. difficile and an older study showed that the use of metronidazole for indications other than CDI was protective of subsequent CDI [ 31 ]. A study done in patients with cancer previously identified metronidazole use as a risk factor for CDI [ 32 ] but was confounded by the use of this agent to treat prior CDI episodes. Two other studies have associated metronidazole with CDI infection [ 21 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Severe Clostridioides difficile Infection in Patients with Cancer

et al. 2022

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Introduction: Antibiotic use is a risk factor for Clostridioides difficile infection (CDI). Few studies have correlated use of prior antibiotic classes with CDI, microbiome composition, and disease severity in patients with cancer. We hypothesized that previous antibiotic exposure and fecal microbiome composition at time of presentation are risk factors for severe CDI in patients with cancer.Methods: This non-interventional, prospective, cohort study examined 200 patients with cancer who had their first episode or first recurrence of CDI. C. difficile was identified using nucleic acid amplification testing. Univariate analysis was used to determine significant risk factors for severe CDI. Fecal microbiome composition was determined by sequencing the V3/V4 region of 16 s rDNA encoding gene. Differential abundance analyses were used to single out significant microbial features which differed across severity levels.

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“…Além disso, o antimicrobiano mais utilizado foi a piperacilina+tazobactam, com uma diferença estatisticamente significante entre os dois grupos. Resultados semelhantes foram descritos por Chang et al, (2016) nos EUA.…”

Section: Discussionunclassified

Baixa prevalência de infecções por Clostridioides difficile em Hospitais de Referência em Oncologia

Tenório

Araújo

Lins³

et al. 2021

RSD

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As infecções por Clostridioides difficile (CDI) aumentaram em gravidade e incidência durante a última década. O câncer predispõe os pacientes à CDI, devido à maior exposição aos fatores de risco. O presente estudo teve como objetivo determinar a prevalência, resposta clínica, desfecho, descrever os fatores de risco estabelecidos na literatura em pacientes oncológicos com CDI. O estudo foi realizado em dois serviços de referência em oncologia de Recife/PE e envolveu pessoas com idade ≥18 anos, que apresentaram o quadro de diarreia após 48horas da admissão hospitalar, no período de novembro/2017 a agosto/2019. Para o diagnóstico de CDI foi utilizado o exame Reação em Cadeia da Polimerase em Tempo Real (qRT-PCR). Um total de 156 pacientes foram incluídos, a CDI foi identificada em 7,05% (11/156) dos pacientes estudados, todos isolados foram rastreados e amplificados por qRT-PCR quanto à presença dos genes que codificam as toxinas A e B (tcdA e tcdB), toxina binária (cdtA) e triose fosfato isomerase (tpi). O câncer de mama 27,3% (3/11) e a leucemia linfóide aguda 18,2% (2/11) foram os cânceres mais frequentes; 90,9% (10/11) fizeram uso de antibióticos e 63,6% (7/11) dos casos evoluíram para óbito. Apesar de utilizar a técnica qRT-PCR, que é a mais sensível e específica, a prevalência de CDI foi baixa 7,05% (11/156), não houve registros de casos de CDI graves, sendo a maioria dos casos leves, o que sugere uma circulação de cepas com baixa virulência que determinam menor morbidade e mortalidade.

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Epidemiology of Clostridium difficile infection in hospitalized oncology patients

Cited by 13 publications

References 9 publications

Evaluation and Management of Penicillin Allergy

Evaluation and Management of Penicillin Allergy

Risk Factors Associated with Severe Clostridioides difficile Infection in Patients with Cancer

Baixa prevalência de infecções por Clostridioides difficile em Hospitais de Referência em Oncologia

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